A clinical case of recurrent cold acral foot lesions in a child: diagnostic challenges

Abstract

Manifestations of transient vasospasm of peripheral arteries and arterioles are an infrequent phenomenon in pediatric age, which always prompts an in-depth examination of the patient due to the need to differentiate the causes of its origin and differentiate its nature:primary or secondary. A clinical case of longitudinal observation of a patient for 4 years with Raynaud's syndrome is described.

Aim - to increase the awareness of doctors about Raynaud's phenomenon, clinical features of its course in childhood, differentiation of the nature of occurrence, treatment and prevention options based on the analysis of the observation of a clinical case.

The presented clinical case demonstrates the course of episodic-recurrent acropathia (three episodes during 4 years of observation) with damage to the skin and small vessels of the lower extremities in a child of primary school age, associated with the winter season, with a predominant lesion of the toes in the form of whitening, soreness, the appearance of papules, hemorrhagic elements and epidermolysis. The absence of systemic disorders and minimal changes in laboratory parameters justify the importance of dynamic clinical monitoring of children with recurrent acroischemic manifestations and illustrate the need for an interdisciplinary approach (rheumatologist, dermatologist, immunologist, vascular surgeon), especially with the progression of symptoms, the appearance of painful elements, necrosis or hemorrhagic changes. Verification of the clinical diagnosis remains a prospect subject to monitoring of autoantibodies, capillaroscopy evaluation, examination for genetic autoinflammatory syndromes, and the effectiveness of empirical treatment.

This clinical case demonstrates the need to raise awareness of systemic autoimmune diseases in primary care pediatricians and family medicine physicians, especially in cases of recurrent and seasonally associated skin and vascular lesions. The observation was performed in accordance with the principles of the Declaration of Helsinki. Written consent was obtained from the patient's mother for the publication of its results.

The authors declare that there is no conflict of interest.